Extensive Subcutaneous Emphysema and Ventilatory Failure during Gynecologic Laparoscopic Surgery: A Case Report

Subcutaneous emphysema (SCE) is a relatively common complication of laparoscopic surgery; however, extensive cases associated with ventilatory failure are rare. We report a case of massive SCE with ventilatory compromise during laparoscopic total hysterectomy. A 50-year-old woman underwent laparoscopic total hysterectomy for uterine fibroids associated with menorrhagia. Shortly after the vaginal incision, a sudden increase in end-tidal CO₂ levels and ventilatory failure occurred. Extensive SCE was subsequently observed, with emphysema extending from the neck to the thighs. The patient’s respiratory status stabilized after reducing insufflation pressure and increasing both tidal volume and respiratory rate. A postoperative chest X-ray showed no evidence of pneumothorax or mediastinal emphysema. She was safely extubated, monitored in the general ward, and discharged on postoperative day four. Possible contributing factors include tissue fragility and surgical technique. Early recognition and prompt intervention, through close communication with the anesthesiologists and operating room staff, are essential in managing such complications.